Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth.
Pharmacist II, Clinical Prior Authorization
Location
United States
Posted
1 day ago
Salary
$105K - $131K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Company
NavitusAbout Us
Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.Pay Range
USD $105,271.00 - USD $131,588.00 /Yr.STAR Bonus % (At Risk Maximum)
7.50 - Pharm, Supvr, AsMgr, SrCSEII, PrgMgr, SrPrgMgr, SrProdMgrWork Schedule Description (e.g. M-F 8am to 5pm)
M-S 8am- 6pm CTRemote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Overview
Navitus Health Solutions is seeking a Pharmacist II, Clinical Prior Authorization to join our team!
The Pharmacist II, Clinical Prior Authorization will be responsible for performing utilization management reviews, performing duties related to drug utilization review, mentoring new hires, testing of the prior authorization system, identifying queue priorities, updating team resources, responding to questions raised by the team, and supporting Customer Care with clinical calls requiring pharmacist intervention. The Pharmacist II, Clinical Prior Authorization will interact daily with other Prior Authorization staff and Customer Care agents. The Pharmacist II, Clinical Prior Authorization will also interact with a number of other roles at Navitus including other Utilization Management Pharmacists, Clinical Account Executives, Program Managers, and Medical Directors.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
- Assist and participate in the Coverage Determination (Certification, Prior Authorization, Exception to Coverage, etc.) process by reviewing all requests which are not clearly approvable based on specified criteria (algorithms), make approval and denial coverage determinations
- Monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers
- Facilitate adjustments to staff priority in order to address queued work with the appropriate priority
- Facilitate communication and education to clients, members, and internal staff regarding clinical daily issues and objectives
- Provide clinical support to operational departments in support of member/patient quality of care
- Provide clinical support of formulary decisions made by the Pharmacy and Therapeutics Committee
- Assist Customer Care, Account Management, and other internal customers in responding to and resolving pharmacy-related inquiries from members, clients, providers, or pharmacies
- Other duties as assigned
Qualifications
What our team expects from you?
- A minimum of a Bachelor’s Degree in Pharmacy or Pharm D
- Current unrestricted licensure as an RPh in the State of the home office of the pharmacist, or the ability to gain reciprocity within 4 months of employment is required
- Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred; and at least 1 year experience as a Navitus Clinical Prior Authorization Pharmacist, or in a comparable role
- Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired
- Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary
- Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences
- Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution
- Requires attention to details in order to ensure projects are clinically, editorially, and systems accurate and can be operationalized
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
#LI-Remote
Location : Address
RemoteLocation : Country
USJob Requirements
- A minimum of a Bachelor’s Degree in Pharmacy or Pharm D.
- Current unrestricted licensure as an RPh in the State of the home office of the pharmacist, or the ability to gain reciprocity within 4 months of employment is required.
- Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred; and at least 1 year experience as a Navitus Clinical Prior Authorization Pharmacist, or in a comparable role.
- Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired.
- Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary.
- Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences.
- Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution.
- Requires attention to details in order to ensure projects are clinically, editorially, and systems accurate and can be operationalized.
- Participate in, adhere to, and support compliance program objectives.
- The ability to consistently interact cooperatively and respectfully with other employees.
- Assist and participate in the Coverage Determination (Certification, Prior Authorization, Exception to Coverage, etc.) process by reviewing all requests which are not clearly approvable based on specified criteria (algorithms), make approval and denial coverage determinations.
- Monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers.
- Facilitate adjustments to staff priority in order to address queued work with the appropriate priority.
- Facilitate communication and education to clients, members, and internal staff regarding clinical daily issues and objectives.
- Provide clinical support to operational departments in support of member/patient quality of care.
- Provide clinical support of formulary decisions made by the Pharmacy and Therapeutics Committee.
- Assist Customer Care, Account Management, and other internal customers in responding to and resolving pharmacy-related inquiries from members, clients, providers, or pharmacies.
- Other duties as assigned.
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance.
- 20 days paid time off.
- 4 weeks paid parental leave.
- 9 paid holidays.
- 401K company match of up to 5% - No vesting requirement.
- Adoption Assistance Program.
- Flexible Spending Account.
- Educational Assistance Plan and Professional Membership assistance.
- Referral Bonus Program – up to $750!
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